AMT for Bullous and Band Keratopathy

                Band & Bullous Keratopathy

             Before AMT                                After AMT            

One of two methods of amniotic membrane transplantation (AMT) can be used depending on the amount of stromal loss following the debridement of loose epithelium using a dry Weckcel or by blunt scraping.

If the defect includes no/minimal stromal loss, suture a layer of amniotic membrane (AM) (AMNIOGRAFT® size 2.0 x 1.5 cm) with the stromal surface facing down toward the healthy stroma using 10-O nylon in either interrupted or running (either zig-zag or purse string). Alternatively, PROKERA™ can be inserted as an overlaid graft. Epithelial healing will take place underneath the layer of AM.

If the epithelial defect includes notable stromal loss, a surgical technique similar to “epikeratophakia” is appropriate. After removal of the band keratopathy or bullous epithelium prepare a lamellar pocket to allow insertion of the membrane to ensure that epithelialization will take place on the top, but not underneath the membrane.

First, a superficial trephination (a quarter turn) up to 8 or 9 mm in diameter is performed on the corneal surface. Then a lamellar pocket 2-mm deep is created 360° toward the limbus using a crescent blade. After the lamellar pocket is created, the AM will be secured to the corneal surface using either fibrin glue or 10-O nylon sutures.

If fibrin glue is used to secure the AM, the membrane should be placed on the eye surface outside of the defect area with stromal side up. Apply the thrombin component of the fibrin glue to the defect area and apply the fibrinogen component of the glue to the stromal surface of the AM and flip the membrane to cover the defect with stromal surface down. Use a muscle hook is used to stretch the membrane over the defect and tuck it in the lamellar pocket.

Alternately, AM can be secured to the corneal surface using 10-O nylon sutures.

Videos

Band Keratopathy Surgery Video: Lamellar Keratoplasty performed for band keratopathy followed by the use of amniotic membrane with fibrin glue OSREF Lamellar Keratoplasty Surgery Sample

Band & Bullous Keratopathy Surgery Video: Surgery to correct band and bullous keratopathy followed by amniotic membrane transplantation OSREF Amniotic Membrane Transplantation for Bullous Keratopathy

Papers

Click here to view PubMed.gov's list of papers published on the use of Amniotic Membrane for Bullous Keratopathy. (To update this list, click the "Go" button next to the search box at the top of the screen.)

Click here to view PubMed.gov's list of papers published on the use of Amniotic Membrane for Band Keratopathy. (To update this list, click the "Go" button next to the search box at the top of the screen.) 

 

 

Click here to view standard surgical supplies used for AMT.

Click here to view standard Post-operative care for AMT

Click here to go back to the main Corneal Indication page.

Click here to go to the Main Medical Education page.